Adoption Application
Name of animal you would like to adopt *
Are there any other animals you would be interested in? *
Name *

First
Last
Age *
Email *
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Main Phone # *

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Alternate Phone #

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Veterinary Information *
Please provide Veterinary Referece (Name/City/Phone)
Your Employer *
Your Occupation *
Work Hours *
Household members' names and ages *
Occupation of adult household members
Does anyone in the household suffer from allergies *
 Yes 
 No 
Type of Residence *
 Single Family Home 
 Duplex/ Townhome/ Condo 
 Apartmnt 
Do you own or rent? *
 Own 
 Rent 
If you rent, can you have pets?
 Yes 
 No  
Landlord Name & number
Please list all current pets *
(Names/Breed/Age/Gender/if Altered)
If you have cats are they..
  Indoor  
 Outdoor  
 Indoor/ Outdoor 
Have your cats been tested for
 FeLV 
 FIV 
 Both 
Are any positive
 Yes 
 No 
What Brand & type of cat food do you feed
If you have dogs are they
 Indoor 
 Outdoor 
 Both 
How is your dog(s) with other dogs and/or cats?
Does your dog(s) have any special needs?
What Brand and type of Dog food do you feed?
Please list all past pets and reason they are no longer with you. *
Name/Breed/Age/Gender/if altered/Reason no longer living with you.
How many hours a day will the adopted animal be alone *
Where will this pet be kept when alone? *
Are you willing to work with this pet if it needs housebreaking help? If so how? If not why not? *
Do you have a fenced yard? Please describe. If not how do you intend to let the pet relieve him/herself? *
Are you willing to take your pet to obedience class? If no, why not? *
What will you do with this pet when you are out of town? *
Who is this pet for? Who will be primary caregiver? *
Have you ever applied to adopt with another organization? If yes, which one(s) *
Have you ever adopted from another organization? If yes, which one(s) *
What issues are you not willing to accept? *
How long do you plan on keeping this pet? *
If you could no longer keep this pet what would you do with it? *
Do you plan to declaw?
 Yes 
 No 
Cat applications only
Are you willing to submit to a home visit before and after adoption? If not, why? *
How much money are you willing to spend on this pet if it becomes sick or injured? *
Has everyone in the home agreed on this pet? *
 Yes 
 No 
How will you discipline this pet? *
Please provide 3 references *
Only 1 may be related
How did you hear of us? *
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Annie's Little Angels Humane Ed. & Small Breed Dog Rescue - P.O. Box 1594 - Plainfield, IL 60586 - rescue@annieslittleangels.org